Background

Data on the clinical course and outcomes of pediatric patients with cytomegalovirus (CMV) infection complicating acute severe ulcerative colitis (ASC) is very limited. The aim of our study was to compare the outcome of CMV-positive and negative pediatric ASC.

Methods

This was a multicenter retrospective case-controlled study, from centers in Europe and Israel. We included CMV-positive pediatric patients hospitalized for acute severe colitis and compared their outcomes (rate of colectomy during hospitalization and up to 1 year from the hospitalization) to matched CMV-negative controls

Results

A total of 56 children from 10 centers were included. The patient cohort included 23 (41.1%) males/ 33 (58.9%) females, with a median age of 11.5 (interquartile range (IQR) – 7–14) years. Fifty-two (92.9%) of the patients had extensive/pan-colitis colitis and the rest left sided colitis, with severe disease in 52 (92.9%) of the patients and moderate in 4 (7.1%). Fifteen patients were CMV-positive and 41 – CMV-negative. Significantly higher proportion of CMV positive patients were resistant to intravenous corticosteroids (p=0.009). After diagnosis of CMV infection, 14/15 patients were started on gancyclovir (5 mg/kg – 5/14 (35.7%) and 10 mg/kg – 9/14 (64.3%). During hospitalization, 3 (20%) CMV positive and 3 (7.8%) CMV-negative patients required colectomy (p=0.17). By 12 months of follow-up, 5 (33.3%) and 5 (12.5%) CMV positive and negative patients required colectomy, respectively (p=0.049). Previous anti-TNF exposure and Pediatric Ulcerative Colitis Activity Index score on index date were significantly associated with the risk of colectomy during hospitalization and by 12 months (p=0.037 and p=0.01 for previous anti-TNF exposure and p=0.021 for PUCAI) on univariate analysis, however none of the factors including CMV positivity retained significance on multivariate analysis.

Conclusion

A higher prevalence of CMV positivity was found in pediatric UC patients who required colectomy within 12 months of index hospitalisation, however the difference was not statistically significant on multivariate analysis. Further studies are merited to clarify the impact of CMV infection on the outcome of acute severe colitis in pediatric patients